- July 20, 2023
- Posted by: Josh Knoll
- Category: Health Systems
Medical coding is complicated and requires extensive subject matter expertise. This revenue cycle task is such a headache that over 23% of 556 C-level executives at health systems and hospitals told the Healthcare Financial Management Association’s (HFMA) Pulse Survey program that it was “among the most time-consuming tasks at their organization”.
Despite being time-consuming, medical coding is important. And that is why, as the currently financial and operational challenges are expected to continue for the healthcare industry even in 2024, decision-makers at healthcare organizations are trying their best to do as much as they can with whatever resources they have to improve coding accuracy.
But all efforts to optimize health system billing and coding operations have been seriously impacted by issues like staff shortages, high staff turnover and rising labor cost. Therefore, to ensure optimum utilization of available resources to maximize reimbursement for provided care and avoid fines, health systems and hospitals must make sure they don’t make the coding mistakes listed below:
Health System Coding with low levels of specificity
Medical coding that fails to capture every medical procedure or service from the details mentioned in medical reports and physicians’ notes has low level of specificity. This type of coding issue can result in underpayment by insurers.
Not following the most updated set of medical coding guidelines
Coding manuals are updated almost every year to include new procedures or clearly define existing procedures or services to eliminate ambiguity. It is vital that health system coding staff follow updated coding guidelines to ensure accuracy in coding operations.
Health system coders’ restricted access to providers
Medical coders at health systems are often unable to connect with providers to seek clarifications on complex claims. In such cases, coding staff may need to use codes with low levels of specificity. And in doing so, their reimbursement claim may get denied by the insurer. Thus to avoid this coding staff should have easy access to healthcare providers to clarify any issues they may face while coding.
Healthcare providers often miss out on documenting important details that have helped them in deciding upon a suitable procedure or service. This leaves coding staff with incomplete information to code to a high degree of specificity and can result in claim denial or underpayment.
Upcoding, undercoding and overcoding
In simple terms upcoding is incorrect coding performed to get a higher compensation from the insurer. Undercoding is coding with a low level of specificity where the coder fails to assign codes for all the services performed. Overcoding is the assigning of inaccurate codes that result in higher reimbursement. Whether intentional or not, these medical coding errors can result in fines, underpayment and even audits.
Besides avoiding the medical coding error mentioned above, health systems must also invest in regular training of coding staff to ensure elimination of knowledge gaps.
For queries about our cost per FTE or to book a free consultation on how to optimize health system coding operations, please reach out to Sunknowledge Services Inc., a HIPAA-compliant RCM company with nearly decades of experience in handling outsourced medical billing, coding, prior authorization and A/R management services.